Even as a presidential commission has urged massive improvements in the treatment of wounded soldiers and veterans, a free, highly regarded brain-injury program sits idle.

Project Victory, the creation of the staff at Memorial Hermann/TIRR, has a three-year, $3 million budget, plus equipment, space, and perhaps most importantly, three decades of institutional experience in treating brain injuries.

The creation of the VA project may have been spurred by widespread awareness that soldiers are returning from the war front with multiple injuries — and widespread criticism that the federal government is failing to take adequate care of troops risking their lives for their country. A report released Wednesday singled out treatment for brain injuries, which are frequently misdiagnosed or not diagnosed, as an area needing attention and improvement.

Levels of impairment

Dr.
Helene Henson
, in charge of rehabilitation services at the
Houston VA hospital
, said the staff was not reacting to any sort of criticism and had not reneged on its agreement with Memorial Hermann/TIRR.

Part of delivering good patient care, Henson said, was adding the day treatment program for veterans with mild brain injuries.

Henson said the VA promised to refer vets with moderate to severe brain injuries to Memorial Hermann/TIRR, and that the hospital staff simply doesn't have any patients with those levels of impairment.

"They're not coming to us," Henson said. "We're seeing a very different type of impairment than we originally thought we'd be managing."

"I think the issue is that our expectations have changed over time," Henson said. "When we first sat down with the TIRR staff, we were hearing the same thing as everybody else — that there were all these moderately and severely brain injured patients out there and that they needed our help."

They simply haven't materialized, Henson said.

"Though this may not be good news for the original (Memorial Hermann/TIRR) project, it is good news for our patients," Henson wrote in an e-mail.

Adkins said the VA staff is quibbling over semantics, and that officials there originally agreed to share their brain-injured patients without regard to mild, moderate or severe diagnoses.

"I don't want to challenge the VA," Adkins said. "We think there are hundreds of vets who can use our help, and we are ready to serve at no cost to them or taxpayers, either."

Call from California

Work on the Memorial Hermann/TIRR project began last summer, when the staff received a call from the
California Community Foundation
, a nonprofit philanthropic group based in Los Angeles.

Adkins said the foundation was interested in helping Americans who sustained brain injuries in the military campaigns in Iraq or Afghanistan. The group focused on Texas because of the large number of soldiers deployed from the state and Memorial Hermann/TIRR because of its experience and reputation.

First, however, the staff had to submit a grant that spelled out a treatment plan. Dr. Gerard Francisco, associate director of the institution's brain injury and stroke team, envisioned a program that picked up patients from the local VA hospital at the conclusion of their conventional medical treatment.

Project Victory, he said, would help them reintegrate into family, school, work and community life.

"We're not competing with the VA," he stressed. "We're collaborating."

Francisco said patients need customized treatment plans that run the gamut from psychological services to occupational therapy. The idea, he said, is to help patients with all their issues, including mental health problems such as depression and post-traumatic stress syndrome.

Monthlong stay

The grant provides for 65 patients a year to flow through the program, located in a spacious and colorful rehabilitation facility at South Braeswood and Kirby. They will stay roughly a month, and those living outside Houston qualify for free housing in nearby hotels.

Family members are welcome, too, Francisco said.

"Brain injury patients may remember their phone number," he said, "but not what they had for breakfast. They may have gone off to war meek as lambs but come back irritable and demanding. It's not unusual for spousal relationships to deteriorate or for the husband or wife to say, 'This is not the same person I married.' ... Those without visible injuries may look the same, but inside, they're different."

It's common, Francisco added, for brain injuries to be missed or misdiagnosed.

"We believe 60 percent of all soldiers injured in explosions also have some kind of brain injury, mild or severe," he said.